The MADI plication - a revised technique

A comparison study of patients who underwent minimally invasive strabismus surgery (MISS) with a total dissection of the plicated part of the rectus muscle and those who had MISS where only a marginal dissection was performed.

Surgical techniques for reducing the conjunctival incision size in minimally invasive strabismus surgery (MISS) have been developed (see New MISS technique is a hit) helping to drastically reduce tissue trauma and postoperative discomfort for patients. Over the years strabismologists have used a number of access techniques for horizontal muscle recession, plication or resection.1-5

"I wanted to find a new, even less traumatic minimally invasive plication technique using no spatula, compared to the standard MISS procedure," explained Dr Mojon. "So, rather than undertake a total dissection (TODI) I performed only a marginal dissection (MADI) of the plicated part of the muscle."

The study


For those who underwent both MADI and TODI plication but who required revision surgery or retroequitorial fixation sutures, vertical rectus muscle surgery or simultaneous surgery of an oblique muscle were excluded.


Orthoptic examinations were conducted postoperatively on Day 1 and after 6 months for both groups of patients. Only those with a complication or not referred by an ophthalmologist were seen at Dr Mojon's department. The remainder were followed up by referring ophthalmologists in between Day 10 and Week 4.

Measured outcomes

"The outcomes examined included alignment, vision variations, binocular single vision, refraction, conjunctival abnormalities, dose-response relationship and number and types of complications experienced during the six months following the operation," said Dr Mojon.

The modified technique for MADI MISS